When Politics Is Personal

Published: September 15, 2002

(Page 3 of 5)

In 1996, Domenici and Wellstone enjoyed their first success after four years of trying to overcome Congress's reluctance to address the problem of inequitable and inadequate insurance coverage for mentally ill Americans. Making a lot of compromises, they won approval for what Domenici now calls ''mental illness coverage lite,'' a first step. The Clinton White House helped, and especially Tipper Gore, who a few years later would disclose her own experience with depression. Newt Gingrich, then the Republican speaker of the House, didn't actively assist but, after a visit from Domenici, he didn't block the legislation either -- which mental-health advocates attribute partly to the fact that Gingrich's mother suffers from bipolar disorder.

Still, the Mental Health Parity Act of 1996 was limited in nature and in effect. It mandated equal annual and lifetime dollar limits for mental and physical benefits; lifetime limits for mental-illness coverage used to be capped at about $125,000, compared with about $1 million -- or sometimes no limit -- for physical disorders. But it allowed employers to comply with the letter rather than the spirit of the law, shifting their costs by raising co-payments and deductibles or lowering limits on hospital days and outpatient visits.

Many states, meanwhile, introduced mental-health parity laws that go further than the federal government's. But even those states possess limited ability to regulate self-financed employer health plans, so Domenici and Wellstone wanted a broad piece of federal legislation that would set the standard. With the 1996 law due to expire by year's end anyway, they are pushing to create the first comprehensive mental-health equitable treatment act.

Mental-health advocates say it will make things infinitely fairer. Without parity, the middle-class parents of a newly psychotic 19-year-old son, say, might discover they have a 30-day lifetime limit on psychiatric hospitalization; that limit might be reached before his illness is even diagnosed, much less treated. They would be left then with three options: go into debt, forgo treatment or turn to the overburdened public sector. If their son had been in a serious car accident, they would face no such predicament.

The Domenici-Wellstone law does make some allowances for the business community's concerns. It does not mandate coverage of mental illnesses; it mandates equal treatment of physical and mental illnesses where such coverage exists. It exempts businesses with less than 50 employees. It doesn't include substance abuse. But insurers and employers are tired of Congress's interference, and they do not see this as a civil rights issue. ''There is no right to health care,'' says E. Neil Trautwein, director of employment policy for the National Association of Manufacturers. ''If this issue gets cast that way, it's unfair, and it kind of makes us look like the bad guys. Our members are already providing voluntary coverage.''

Many insurers and employers maintain that the parity legislation is misguided, that it will end up backfiring and prompting some providers to drop mental-health coverage entirely. They say that parity for mental-illness coverage, as designed, will drive up health-care costs and that the legislation defines mental disorders so broadly that people with problems like caffeine intoxication or jet lag will abuse the system.

Recently, however, these opponents have lost ground. While Domenici had a couple dozen co-sponsors in 1992, when he first introduced mental-health legislation, he now has 66 senators with him on this. He has been unsuccessful, however, in reaching across the Hill and persuading the House leadership to join him, even though a majority of House members are on record as supportive. And that's why Domenici paid his visit to the Oval Office in July of last year.

Domenici was pleasantly surprised that Bush took the issue seriously enough to ask Andrew Card, his chief of staff, to attend. The senator wasn't certain whether he needed to start at the beginning, to explain that diseases of the brain are as real as diseases of other organs and that they are treatable. ''I just plain didn't know where he was on the mental issue,'' Domenici said. ''But I was only a few sentences into it before he stopped me and said, 'On the issue of is this a disease, I've already gone up that mountain.'''

Dr. Samuel Keith, chairman of the psychiatry department at the University of New Mexico, participated in a round-table discussion on mental health with Bush in the spring. The president said that he had grown up thinking people with mental problems should just read the Bible and try harder, Keith said. But then, according to Keith, the president told the round-table participants that a close friend in Texas who was profoundly depressed went off and got treatment and returned a transformed man. This opened his eyes, the president said.

The president was also sensitized by the suicide last year of Heinz Prechter, a Michigan businessman, Domenici said, although he was not sure whether Bush had told him this or someone else had. Prechter, who made his fortune after introducing the sunroof in the United States and was a generous donor to the Republican Party, killed himself at the end of a lifelong struggle with bipolar disorder.